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Permit
q CITY OF TIGARD PLUMBING PERMIT 11 1 s COMMUNITY DEVELOPMENT Permit #: PLM2013 00002 T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/03/2013 Parcel: 2S104BD01200 Jurisdiction: Tigard Site address: 13585 SW FERN ST Project: Wiles Subdivision: OBRS HEIGHTS Lot: 11 Project Description: (1) clothes washer, (3) lavatories, (2) water closets,(1) tub and (1) shower Contractor: WESTERN PLUMBING Owner: WILES LIVING TRUST 9460 SW TIGARD AVE SUITE 101 BY WILES, NICOLETTE YVONNE TR TIGARD, OR 97223 13585 SW FERN ST TIGARD, OR 97223 PHONE: 503 - 639 -5296 PHONE: FAX: 503 - 684 -9015 FEES Quantity Description Date Amount 1 ea Clothes Washer 01/03/2013 $25.02 Specifics: 3 ea Lavatories 01/03/2013 $75.06 2 ea Tub /Shower /Shower Pan 01/03/2013 $25.02 Type of Use: SF 2 ea Water Closet 01/03/2013 $50.04 Class of Work: ALT 1 12% State Surcharge - 01/03/2013 $21.02 Type of Const: Plumbing Occupancy Grp: Stories: Total $196.16 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. xj Issued By: b) , n t Permittee Signature: ia Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures RECEIVE'; FOR OFFICE USE ONLY City of Tigard Received III • g JAN 0 3 2 013 D 3 //3 Permit No :19(44 '1, ,1 3 , �:6, i v � 13125 SW Hall Blvd., Tigard, OR 97223 3 fit/ �L /V�' _ Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date/By- Other Permit No.: TIGARD Inspection Line: 503 639.4175 C ITY OFTIGARD DateReadyBy: J S O See Pa e Internet: www.tigard q I n 2 for .. 3 1ILDING DIVISION �{ o» wc> _ l l * Suppleme at a lInf orma ti o n ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total I] Addition/alteration/replacement ❑ Other. New 1 dwellings (includes 100 ft. for each utility connection) CATEGORY OIL cONSntucrzoN SFR (1) bath 312.70 1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 1:1 Accessory building ❑ Multi - family SFR (3) bath 500.32 (11 Master builder Each additional bath/kitchen 25.02 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 Jd); SITE FORMATION =AND ,T;letwitoN Site utilities: Job site address: /35 8.S 51 / Fe-2rV Catch basin or area drain 18.76 City/State/ZIP: TG Af`D 0 g L 7�� Drywell, leach line, or trench drain 18.76 / / Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 /,�� G�� S � . Mf Clothes washer / 25.02 OZ L ! Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 t] TIitOPERTY owNER U Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 CI APPLICANT' © CONTACT tritsor Interceptor/grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Contact name: 12.51 Roof drain (commercial) 12.51 Address: _ Sink/basi�Ilavatocy 5 25.02 7s, a_ City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) f Fax : ( ) (T oor /shower pan 12.51 ) J `'-` E -mail: Urinal 25.02 CON, OR Water closet ,, `' • 25.02 Water heater 37.52 Business name: Western Plumbing, Inc. Water piping/D W V 56.29 Address: 9460 SW Tigard Avenue Suite 101 Other: 25.02 City/State/ZIP: Tigard, OR 97223 Subtotal 25 ;.k Phone: (503) 639 -5296 Fax: (503) 684 -9015 Minimum permit fee: $72.50 CCB Lic.: 2439 Plumbing Lic. no.: 34 - 29PB Plan review (25 %ofpermit fee) --- State surcharge (12% of permit fee) r / .r Authorized signature: tiji i --7 TOTAL PERMIT FEE 9 !... Print name: Dana Jensen Date: s This permit application expires if a permit is not obtained within 180 days /�_ after it has been accepted as complete. er...n.11...Anlnmr aH 1.v T.i J'rnmty A..:l.i:n., Tn.inal... 0 • 13nn..4 1G ?k i 4% Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: Inspection Report 2633 Camino Ramon Dr San Ramon, CA, 94583 Tel: 999-999-9999 13585 SW FERN ST, TIGARD, OR, 97223 Residential - Plumbing 322 Shower pan 01/23/2013 00:00 PLM2013-00002 Scheduled Violation Summary: Inspector Contractor